Journal of Evolution and Health

Volume 2
Issue 1 Special Issue of the Ancestral Health Article 10
Symposium 2016

3-14-2017

Diet, kidney stones and kidney failure

lynda frassetto
UCSF, lynda.frassetto@ucsf.edu

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Part of the Disorders of Environmental Origin Commons, and the Nutritional and Metabolic
Diseases Commons

Recommended Citation
frassetto, lynda (2017) "Diet, kidney stones and kidney failure," Journal of Evolution and Health: Vol. 2: Iss. 1, Article 10.
https://doi.org/10.15310/2334-3591.1056

This Extended Abstract is brought to you for free and open access by Journal of Evolution and Health. It has been accepted for inclusion in Journal of
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Diet, kidney stones and kidney failure
Keywords
vascular disease, hydration, calcium oxalate, protein, paleo

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 frassetto: Diet, kidney stones and kidney failure

Diet, kidney stones and kidney failure

Most common renal diseases are due to vascular disease, much of which is related to
dietary factors

Both kidney stones and the most common kinds of chronic kidney disease (CKD) are in part
affected by what we eat. CKD is essentially a vascular disease, and therefore worsened by
diabetes, high blood pressure and atherosclerosis [1, 2]. Subjects who are overweight or obese
are particularly prone to all of these medical illnesses. The vascular disease that affects the
kidneys also affects the other organs in the body, such as the heart and brain, this vascular
disease appears to be increasing over time in all ethnic groups [3], and subjects with CKD are at
increased risk of death [4]. In controlled studies, Paleolithic type diets have been shown to
improve blood pressure control, blood sugar control and to help subjects lose weight to a
greater degree than American Diabetes Association or Mediterranean diets [5, 6, 7]. Paleolithic
diets have also been shown to improve vascular tone and elasticity, which is important for
vascular health [8].

Common renal stones are also related to dietary factors

In western countries, kidney stones tend to be made out of calcium, such as calcium oxalate,
uric acid, or a combination of the two. Many dietary factors are important in kidney stone
formation, including hydration status, urine pH, intake of protein, fructose, calcium and table
salt, and the presence or absence of metabolic syndrome [9, 10]. Presumably due to an
increasingly warm climate, the presence of kidney stones is now found at higher latitudes than
previously, and the combination of kidney stones and CKD has been increasingly described in
hot climates in agricultural workers with inadequate intake of water during the daytime
hours [11].

The presence of kidney stones increases with increasing free fructose intake (e.g., as in
fructose corn syrup), and is thought to be due to increased uric acid production from the AMP
released during the first step of fructose metabolism to fructose-1-phosphate [12]. Obesity and
having a high waist-to-hip ratio is also associated with an increased risk for kidney stones [13].

Subjects at risk for calcium stones appear to have an increased propensity to absorb calcium
from the gut compared to subjects without kidney stones [14]. In a low calcium environment,
such a factor would help improve calcium balance, but would be a hindrance in a high calcium

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 Journal of Evolution and Health, Vol. 2 [2017], Iss. 1, Art. 10

environment. Calcium stone formers then excrete more calcium in the urine than non-stone
formers [15]. High salt intake also increase urine calcium excretion and adds to the acid load
due to the lack of fruits and vegetables in typical western diets [15]. The combination of all of
these factors (high salt, acid and calcium) not only make calcium kidney stones more likely to
form, but predispose to damage to the blood vessels and direct damage to the kidneys. We are
therefore now increasingly recognizing a greater proportion of people with CKD related to
having kidney stones [16].

Paleolithic type diets may help

Inasmuch as Paleolithic type diets lower salt intake, tend to lower calcium intake, and lower diet
acid production, they would help decrease the probability of developing kidney stones. Low salt
intakes also generally improve blood pressures, especially in people with metabolic syndrome,
who also tend to have high blood sugar and high lipid levels [17]. Therefore, Paleolithic type
diets might be particularly helpful in those people most predisposed to developing calcium or
uric kidney stones, and help those predisposed to developing progressive kidney disease from
hypertensive, diabetic, atherosclerotic vascular disease.

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DOI: 10.15310/2334-3591.1056
 frassetto: Diet, kidney stones and kidney failure

References

1. http://www.globalsherpa.org/urban-design-health-obesity

2. https://www.usrds.org/: US Renal Data System CKD 2010, NHANES 19992006 participants

age 20 & older.

3. http://kidney.niddk.nih.gov/kudiseases/pubs/kustats/#3

4. https://www.usrds.org/: US Renal Data System CKD 2005; Point prevalent Medicare patients
age 66 & older. Adj: age/race/hospitalization/comorbidity; ref: 2005 cohort.

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more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia
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12. Taylor EN, Curhan GC. Fructose consumption and the risk of kidney stones. Kidney Int.
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14. Sorensen MD, Eisner BH, Stone KL et al. Impact of calcium intake and intestinal calcium
absorption on kidney stones in older women: the study of osteoporotic fractures. J Urol.
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15. Lemann J, Jr. Chap 7: Urinary calcium excretion and net acid excretion: effects of dietary
protein, carbohydrate and calories, in Urolithiasis And Related Clinical Research, Schwille PO
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16. Rule AD, Bergstralh EJ, Joseph Melton L III, Li X, Weaver AL, LieskeJ. Kidney stones and
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DOI: 10.15310/2334-3591.1056